| NPI | 1750645321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL U03112) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2015-07-02 |